Evidence map›Paper›PMID 40622567›Full record

ArticleSupportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer2025

Clinical practice guideline- and care pathway-inconsistent care following implementation of adapted infection management care pathways.

Ida Mehrdadi, Priya Patel, Paula D Robinson, Catherine Mark, Adam P Yan, Sarah Alexander, Michaila Aitcheson, Sadie Cook, Stephanie Cox, Paul Gibson and 6 more

Abstract readMulticenter Study
PubMed Publisher
In one paragraph

Article in Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

16 authors.

Ida Mehrdadi *Child Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Priya Patel *Deparment of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Paula D RobinsonPediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON, M5G 1V2, Canada.
Catherine MarkDivision of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Adam P YanDivision of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Sarah AlexanderDivision of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Michaila AitchesonDivision of Hematology/Oncology, Children's Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.
Sadie CookChild Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Stephanie CoxDivision of Haematology/Oncology, McMaster Children's Hospital, Hamilton Health Sciences Centre, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
Paul GibsonPediatric Oncology Group of Ontario, 480 University Ave, Suite 1014, Toronto, ON, M5G 1V2, Canada.
Donna L JohnstonDivision of Hematology/Oncology, Children's Hospital of Eastern Ontario, 401 Smyth Rd, Ottawa, ON, K1H 8L1, Canada.
Alicia KooDeparment of Pharmacy, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Jennifer SeelischDivision of Hematology/Oncology, Children's Hospital London Health Sciences Centre, 800 Commissioners Rd E, London, ON, N6A 5W9, Canada.
Deborah TomlinsonDivision of Haematology/Oncology, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
L Lee DupuisChild Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada.
Lillian SungChild Health Evaluative Sciences, The Hospital for Sick Children, 555 University Ave, Toronto, ON, M5G 1X8, Canada. Lillian.sung@sickkids.ca.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeImpact of infection management care pathway implementation is uncertain in pediatric cancer. Objective was to determine whether fewer patients received clinical practice guideline (CPG)- and care pathway-inconsistent care after implementation of an adapted infection management care pathway compared to pre-implementation.

methodsWe implemented adapted infection management care pathways based on CPGs for prophylaxis, and initial, ongoing, and prolonged fever and neutropenia (FN) management in three centers. We conducted a retrospective chart review, sampling patients with episodes of high- and low-risk FN, pre- and post-implementation of the care pathway. Up to five chemotherapy cycles per patient were adjudicated for antibacterial and antifungal prophylaxis care pathway inconsistency. Among these cycles, FN episodes were identified, and one was randomly chosen per patient. CPG- and care pathway-inconsistent actions were adjudicated.

resultsThree hundred seventy-five patients were assessed for eligibility, and 272 were included. For prophylaxis, 115 pre-implementation and 57 post-implementation high-risk cycles were evaluated. For FN, 82 pre-implementation and 42 post-implementation episodes were evaluated. Antifungal prophylaxis inconsistency decreased in the post-implementation period compared with the pre-implementation period (P = 0.023). However, there were no other significant differences in CPG- or care pathway-inconsistent actions by period. In both periods, CPG- and care pathway-inconsistent actions were common.

conclusionsImplementation of adapted care pathways for infection management was associated with fewer patients receiving care pathway-inconsistent antifungal prophylaxis. However, it did not reduce other CPG- or care pathway-inconsistent actions. Inconsistent actions for FN management were common in both periods. Targeted approaches are required to improve care pathway-consistent infection management in pediatric cancer patients.

Indexed as

Critical PathwaysGuideline AdherenceInfection ControlNeoplasmsPractice Guidelines as TopicAdolescentAnti-Bacterial AgentsAntibiotic ProphylaxisAntifungal AgentsChildChild, PreschoolFemaleFeverHumansInfantMaleAnti-Bacterial AgentsAntifungal AgentsCancerCare pathwayClinical practice guidelineInfectionPediatric

Identifiers

PMID40622567

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.